Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions

Abstract

Systematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care. Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing. FPs possibly need more training in handling parental concern without inappropriately prescribing antibiotics.

The effects of the primary health care providers’prescription behavior interventions to improve the rational use of antibiotics: a systematic review

“…There were nine cluster random control trials, [15][16][17]19,21,[23][24][25]29 two matched-pair cluster-randomized trials, 26,27 two RCTs, 22,31 two before and after intervention studies, 20,28 one quasi-experimental trial 30 and one interrupted time series study. 18…”

“…Of the 17 studies, ten were conducted in Europe, [15][16][17][18][19][20][21][22][23][24] four in China, [25][26][27][28] three in the USA. [29][30][31] Table 1 provides a summary of the key characteristics of each included study.…”

“…13 of the studies measured a change in antibiotic prescription rate or the odds ratio of antibiotic prescribing. 15,16,17,[20][21][22][23][24][25][26][27]29,30,31 The antibiotic prescription rate defined as the proportion of prescriptions for specific disease that include at least one antibiotic. One of the studies measured the impact of interventions on the rate per 1000 registered patients dispensed one or more 4C antimicrobial prescriptions (co-amoxiclav, cephalosporins, fluoroquinolones and clindamycin).…”

C-reactive protein: guiding antibiotic prescribing decisions at the point of care

“…13 Based on the study by Lemiengre and colleagues, use of CRP to guide antibiotic prescribing decisions for children cannot be recommended either. 1 The only study that showed an effect of physician use of CRP in children was a large multicentre RCT in 10 primary healthcare centres in Vietnam. It recruited over 1000 children, and reduced antibiotic prescribing from 77% to 68% in children with acute infections.…”

“…1 They were randomised to a brief intervention that elicited and attempted to address parent concerns, GP use of a CRP test, both, or usual care. The brief intervention paradoxically increased antibiotic prescribing, while GP use of CRP alone or GP use of CRP plus the brief intervention had no significant effect on prescribing.…”